The Truth About Gluten

For most of her life, Cathy Berzins suffered from intermittent digestive problems and migraines. She had difficulty staying focused. “I just didn’t feel well,” she says. Doctors found nothing wrong. “I wasn’t making it up,” she says, “but I learned to live with it.”

Her gastric discomfort was particularly frustrating, considering she was a cook devoted to healthy foods. She even ground wheat berries herself to make her own bread.

Then she heard someone talk about celiac disease. When people with the autoimmune disease eat gluten—a protein found in wheat, rye and barley—they experience a reaction that can damage the small intestine. The only treatment is to avoid products with gluten.

Berzins is a believer. “Migraine headaches are not an issue for me now,” she says. “I can think more clearly.” She’s embraced the gluten-free diet to such an extent that in May she opened The Birch Tree Café, a gluten-free restaurant inside Good Earth Market, located just outside Bethany Beach.

The eatery is part of a growing movement. These days, hosts and hostesses are facing as many gluten-free guests as meat- and dairy-free diners. Restaurants, including Ulysses American Gastropub in North Wilmington and Home Grown Café in Newark, have gluten-free menus. Grotto Pizza has gluten-free crusts, and gluten-free products share supermarket shelf space with conventional items.

Janssen’s in Greenville upped its offerings seven years ago, in part to cater to a growing number of consumers with dietary concerns. “Any number of our customers just feel better without wheat,” says Eileen Janssen.

And there, perhaps, is the rub. Does everyone on a gluten-free diet truly need to be? Will it help you or hurt you?

The questions can raise some hackles. “People with celiac disease are pretty incensed that so many people without it want to go gluten-free,” says Sharon Howard, a registered dietitian at Christiana Care’s Eugene du Pont Preventative Medicine & Rehabilitation Institute in Greenville, whose daughter has the disease.

People with celiac disease feel they don’t have the luxury of a choice. Even the slightest bit of gluten—picture a communion wafer—can cause a reaction.

Nevertheless, few would argue that they’ve benefitted from the number of gluten-free consumers who’ve made it a choice. Products are becoming plentiful. Sales of gluten-free foods are expected to top $5.5 billion by 2015, and given the numbers, not all those are going to people with celiac disease.

According to the Celiac Disease Foundation, one in 133 people has celiac disease in the United States. That’s a relatively small number considering one in three people has cardiovascular disease.

The wide variety of symptoms traditionally made it hard to diagnose. They range from intestinal issues—gas, constipation or diarrhea—to depression, mouth ulcers, fatigue, joint pain and infertility. You may have stomach pain, but you may not, even though the disease affects nutrient absorption.

A blood test now checks for celiac disease, but patients must eat gluten prior to being tested. Rather than go back on gluten, Berzins, who had been gluten-free for a year when the doctor suggested the test, opted for a DNA test. (This disease runs in families, and her daughter also has it.)

Some people don’t have celiac disease, but they still have trouble with gluten. The journal BMC Medicine published a paper that claims up to 18 million people are “gluten sensitive.” They have a reaction when they reach a certain threshold. “They can probably handle a little cereal in the morning but not a big hoagie roll at dinner,” Howard explains.

Irene Soucy, a dietitian in Beebe Medical Center’s Nutritional Services Department, has seen increased interest in gluten sensitivity. “The media, word-of-mouth and the increased availability of gluten-free foods have helped spur this trend,” she says.

Some gluten-free followers have neither the disease nor the intolerance. They have an allergy or sensitivity to the protein in wheat. They might be fine with barley or rye or wheat’s cousin, spelt.

Then there are those who want to reduce their consumption of genetically engineered grains. “Most of us are eating way too much wheat and grains to process them well,” says April Pedrick of Harvest Market Natural Foods in Hockessin. “Even people without celiac disease might experience bloating. The stuff can sit in the digestive track.

Not surprisingly, some people hope that going gluten-free will cure what ails them. “They eat poorly and want to unscientifically blame a food group,” Howard says. They may decide to play with their diet rather than face a battery of tests. Soucy says about half of her gluten-free clients restricted their diet without a clinical test or biopsy to diagnose celiac disease.

If you’re considering a gluten-free path, be prepared: It’s not an easy road. For one, some of the products have more calories than their conventional counterparts, which is a wake-up call for those whose goal is to lose weight. To make gluten-free products an appetizing alternative, they may contain more sugar or eggs. Consequently, people who grab prepared or packaged substitutes can pack on pounds.

A true gluten-free diet requires vigilance. Regular soy sauce has gluten. So do many vitamins. Malt, Soucy says, is a “hidden” source of gluten. “Barley grain appears as malt or malt flavoring,” she says. Rice or corn cereal, which seems fine on the surface, might have malt flavoring as an additive, she notes.

Cross-contamination is a continual fear. The knife that buttered wheat bread shouldn’t be used to butter rice bread. Some households have two toasters and dedicated cutting boards.

Berzins previously was a partner in Café on 26 in Bethany, which also offers conventional products. She left to devote herself to gluten-free goods because she was too concerned about unintentional cross-contamination. “It’s not negotiable,” she says. “Unless I could ensure no cross-contamination, I had to eliminate gluten from cooking altogether.”

Eating out presents a problem for gluten-free diners. What happens if the kitchen delivers the salad with croutons? Howard has a friend who hides a sugar packet under the lettuce before she sends a dish back to the kitchen. When the new salad arrives, she checks for the packet to see if they just removed the croutons instead of making a fresh salad.

Although Home Grown Café offers a gluten-free menu, there’s no way chef-owner Eric Aber can guarantee an item isn’t unintentionally contaminated. “It’s a can of worms,” he acknowledges. “We won’t use regular soy sauce on a gluten-free dish, but I’m constantly worried about diners and food allergies.”

Those testing the gluten-free waters should also up their food budget. The items aren’t cheap. Gluten-free bread might cost $3 or $4 more than regular bread. Shop around. Products are available at a variety of sources.

Followers also need to make up for the minerals, vitamins, carbohydrates and nutrients that gluten products provide. You’ll miss out on the benefits of enriched wheat flours or whole grains, for instance. “It’s nutritionally a mistake to unnecessarily change your diet,” Howard says.

If you’ve gone gluten-free for some time and you’re not seeing results, you could have an issue with fructans, not gluten. Fructans are present in garlic and artichokes, along with wheat.

For a period of time, many people may experiment with gluten-free foods to see if they notice a difference in how they feel. Marianne Carter tried a gluten-fee diet upon her doctor’s recommendation. (Her issues actually stemmed from thyroid medication.)

Director of the Center for Health Promotion at Delaware State University, Carter was thrilled that there were so many choices, but she was glad to learn she didn’t have celiac disease.

“There is a role for gluten-free products, especially for those who really need it,” she says. “But people shouldn’t feel it’s nutritionally superior if you can handle wheat.”

For Berzins, gluten-free foods are not a passing phase. They’re an important part of her lifestyle. “Natural whole wheat is a good food,” she says. “It’s just that my body doesn’t recognize gluten as friend. It’s a foe.”